| NPI | 1689742686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW 37176) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2014-07-29 |